I saw a patient today a week after his previous visit. He was very angry when I walked in the exam room, and his body language made me a bit uneasy, as often happens when a patient feels I haven't met his or her needs.
"I'm pissed off" he said.
"Why?" I asked.
"Because I've been doped up on prescription opioids the past 16 years and now that I'm off, I realize I didn't need them. My pain today is a zero. The doctors who prescribed to me all these years stole my life."
We talked about mourning the loss of the past 16 years and then moved on. I told him it was time to look forward to the next 16 years.
The opioid epidemic is real, as is pain. But the two epidemics have seemingly crossed paths. People with pain are suffering more than ever, unable to get their medications and turning to illegal and dangerous means of self-treatment. Meanwhile, heroin addicts are dying in droves because of fatally potent batches of fentanyl-laced heroin.
I'm not against opioids. In fact, as a pain specialist I prescribe them quite often. But I’m also aware that they have been dangerously and recklessly over prescribed.
The patient I saw today didn't come to me to get off opioids, he came for more opioids because his doctor stopped prescribing.
I was compassionate yet firm with him. "You have a very serious pain problem,” I said, “But you're also on way more medication than I think is appropriate and you're pain score is still 10 out of 10."
Somewhere along the line we’ve lost our way. Doctors and patients don't have enough time in a brief office visit to properly address addiction. And we haven't been properly trained: we lack the resources and funding to adequately address this epidemic.
We also haven't been taught to recognize which patients are addicts. In fact, some patients don’t even seek addiction treatment because they don’t know they’re addicts.
Unfortunately, this is very common.
Sometimes less is more. If a patient is misusing or overusing his or her meds, doctors have to address it. If you're a person with inadequate pain control or out of control with your meds, discuss it with your physician or find someone else.
We must advocate for these people in pain who might be over medicated and impaired.
With firm limits and compassionate care, we can reign in this devastating problem.
Posts by Melanie Rosenblatt, M.D.
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